Reaching closure with skin stretching. Applications in the diabetic foot.
At the present time, there are no evidence-based protocols outlining the use of the Sure-Closure Skin Stretching System on diabetic, neuropathic wounds. Ideally, surgical correction of the precipitating deformity and appropriate shoe gear accommodation should be performed con-comitantly with skin stretching (as indicated) to achieve an optimal long-term result. For several years, we have used the Sure-Closure device as an adjunctive treatment for diabetic-foot wound closure, and believe that, ultimately, this device more likely will be used in a clinical setting. In this manner, a patient with an open wound may, under aseptic conditions, be sequestered for a period of 1 to 2 hours during a clinical visit to allow for skin stretching. This procedure may be carried out two or three times weekly until closure is achieved. Mechanically assisted delayed primary closure is a relatively new category of wound closure; however, this device is by no means a panacea. Appropriate patient selection and intraoperative judgment are of critical preoperative and perioperative importance when employing this technique. Currently, we are completing a clinical trial comparing mechanically assisted delayed primary-wound closure to traditional treatment and off-loading in a population of high-risk diabetic patients. We believe that this project will better elucidate the relative indications and contraindications with what may be a very effective tool for the diabetic foot specialist.
Armstrong
D G
DG
Department of Orthopaedics, University of Texas Health Science Center, San Antonio, USA.
Wunderlich
R P
RP
Lavery
L A
LA
D062109:Dermatologic Surgical Procedures; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D004548:Elasticity; D005528:Foot / Q000098:blood supply; D006801:Humans; D008833:Microcirculation; D012867:Skin / Q000503:physiopathology*; D013314:Stress, Mechanical; D013523:Surgical Equipment